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Expecting a Surge in U.S. Medical Schools

Peter Allen and Jennifer Sidari, first-year students at The Commonwealth Medical College, a first-year school in Scranton, Pa.Credit
Niko J. Kallianiotis for The New York Times

Peter Allen applied to 30 medical schools after graduating from the University of Pittsburgh last year. Twenty-eight said no.

Of the two that said yes, one had something in common with Mr. Allen: It, too, was starting out in medicine. He enrolled in the inaugural class of The Commonwealth Medical College in Scranton, Pa.

“I was ecstatic that I had been accepted to a medical school,” Mr. Allen said, adding that he would have gone for a master’s in bioengineering if he had not been accepted. “It’s a giant sigh of relief; it secures your plans for the rest of your life really.”

The Commonwealth is one of nearly two dozen medical schools that have recently opened or might open across the country, the most at any time since the 1960s and ’70s.

These new schools are seeking to address an imbalance in American medicine that has been growing for a quarter century. Many bright students were fleeing to offshore medical schools, or giving up hope entirely, when they could not get into domestic schools. Meanwhile, American hospitals were using foreign-trained and foreign-born physicians to fill medical residencies. During the 1980s and ’90s only one new medical school was established.

“Huge numbers of qualified American kids were not getting into American medical schools or going abroad to study,” Dr. Lawrence G. Smith, dean of the proposed Hofstra University School of Medicine, in Hempstead, N.Y., which is not yet recruiting students, said last week. “I think it was a kind of wake-up call.”

The proliferation of new schools is also a market response to a rare convergence of forces: a growing population; the aging of the health-conscious baby-boom generation; the impending retirement of, by some counts, as many as a third of current doctors; and the expectation that, the present political climate notwithstanding, changes in health care policy will eventually bring a tide of newly insured patients into the American health care system.

If all the schools being proposed actually opened, they would amount to an 18 percent increase in the 131 medical schools across the country. (By comparison, there are 200 law schools approved by the American Bar Association.) And beyond the new schools, many existing schools are expanding enrollment, sometimes through branch campuses. While The Commonwealth is an independent school, many of the other new or proposed schools are affiliated with established universities, like Hofstra, which is teaming up with North Shore Long Island Jewish Medical Center; Quinnipiac University in Hamden, Conn.; the University of California, Riverside; Central Michigan University; and Rowan University in Camden, N.J.

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Dr. Lawrence G. Smith, dean of the proposed Hofstra University School of Medicine.Credit
Ángel Franco/The New York Times

Supporters of the expansion say that having more doctors will improve care, by getting doctors to urban and rural areas where they are needed, by shifting care to primary and family practice physicians rather than expensive specialists, and by reducing long waits for people to see a doctor and get the care they need.

But skeptics say that although many parts of the country do need more primary care, American doctors tend to congregate in affluent, urban and suburban areas that already have a generous supply.

They say that doctors create demand for their own services, and that nurse practitioners and physician assistants could fill gaps in medical care at a lower cost.

“When you add more physicians to an area, they just add more services, and their salaries don’t go down anywhere near in proportion to the increased supply,” said Dr. David Goodman, professor of pediatrics at the Dartmouth Institute for Health Policy and Clinical Practice and a practicing physician who has studied work force issues for 20 years. “More care may not be better, but it certainly is paid for,” Dr. Goodman said.

Many of the developing medical schools are well aware of such arguments, and are billing themselves as different from traditional medical schools, more focused on serving primary care needs in immigrant and disadvantaged communities. Administrators say that they expect that approach to be buttressed by a shift in state and federal reimbursements from specialists to primary care doctors.

Riverside County, an inland area with a diverse population including immigrants and Native Americans that has expanded rapidly, has a deficit of about 3,000 physicians, according to Dr. G. Richard Olds, founding dean of the University of California, Riverside School of Medicine.

Riverside has applied for licensing, the first step toward becoming a medical school, and hopes to admit its first four-year class in 2012, and to have 400 students by 2016, a typical size for the new crop of schools. Dr. Olds said his educational focus, building on his background as a tropical disease specialist, would be on prevention and “wellness.”

“I think we have to crank out different kinds of doctors,” said Dr. Olds, who started his new job Feb. 1.

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John Lahey, president of Quinnipiac University, which approved plans for a medical school.Credit
Christopher Capozziello for The New York Times

Whether the demand for new medical schools exists among patients, it clearly exists among prospective doctors.

Dr. Olds said that at his former job as chairman of medicine at the Medical College of Wisconsin, 25 percent of the students came from California. “So obviously there’s a ton of California kids trying to get into medical school traveling a long way.”

The Association of American Medical Colleges, a trade group, has called for a 30 percent increase in enrollment, or about 5,000 more doctors a year. The association’s Center for Workforce Studies estimates that 3,500 more M.D.s will enter graduate training over the next 10 years, roughly half of the 7,000 international medical school graduates now entering medical residencies in the United States every year, according to Edward Salsberg, director of the center.

At Quinnipiac, the trustees last month approved plans for a new medical school, to open in 2013 or 2014, if it passes accreditation. John L. Lahey, the university president, said that the proposed school would build on the university’s existing health sciences programs, and the hope was to recruit at least some students who had worked in health care and wanted to become doctors.

“We certainly think they will be what we tend to call nontraditional students, older, some minority,” Dr. Lahey said.

Six developing medical schools, including The Commonwealth, have received preliminary accreditation, enabling them to begin recruiting students, and six more, including Riverside, have begun the application process, according to the Liaison Committee on Medical Education, which accredits American medical schools. An additional 11, including Quinnipiac, have announced their intention to apply for licensing, according to Mr. Salsberg.

Whatever the expansion may mean for the cost of health care, it is a relief to aspiring doctors like Mr. Allen, who took tough undergraduate courses and had a busy extracurricular life of mock trials, robotics and work as an emergency medical technician. His pre-med adviser told him that with his 3.3 grade-point average, he should apply only to osteopathic schools, but he persisted, and was admitted to The Commonwealth and New York Medical College in Valhalla, N.Y.

He was one of 1,300 applicants for 60 positions (eventually class size will double) in the inaugural class at The Commonwealth, according to Dr. Robert M. D’Alessandri, the president and dean. Mr. Allen has a United States Navy scholarship, but for his classmates, the school took $20,000 a year off the tuition, a reduction of about half, as an incentive to take the risk of a new school.

Given the pent-up demand, Dr. D’Alessandri said, he was not worried that he might produce too many doctors for the good of society. “We should worry about too many lawyers,” he said dryly.

Correction: February 17, 2010

A picture caption on Monday with continuation of an article about an increase in new medical schools in the country misstated the given name of a student at the Commonwealth Medical College in Scranton, Pa. She is Jennifer Sidari, not Jessica.

A version of this article appears in print on February 15, 2010, on Page A1 of the New York edition with the headline: After Years of Quiet, Expecting a Surge in U.S. Medical Schools. Order Reprints|Today's Paper|Subscribe